Provider Demographics
NPI:1891357059
Name:GOODLOE, AVANI ATUL (MFT)
Entity Type:Individual
Prefix:MRS
First Name:AVANI
Middle Name:ATUL
Last Name:GOODLOE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 GLEN LAKES CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5319
Mailing Address - Country:US
Mailing Address - Phone:502-592-5891
Mailing Address - Fax:
Practice Address - Street 1:10300 BROOKRIDGE VILLAGE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4474
Practice Address - Country:US
Practice Address - Phone:502-785-4322
Practice Address - Fax:502-785-4433
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist